Battering as a “pre-existing condition”

In eight states and DC, domestic violence victims (even those who have moved out on the batterer) can be refused health insurance because battering is a “pre-existing condition.” Â In 2006, Republicans killed a legislative provision that would have forbidden that practice. Â Mike Enzi, now one of the “Gang of Six” joined in, and defended, the effort to kill the provision, reasoning that it would increase insurance rates.

Of course the economic logic is straightforward: Â A woman who has battered once is more likely to be battered again. Â So an insurance company management in a competitive environment, struggling to insure as few high-risk people as possible, will be forced to discriminate, unless regulation prevents such discrimination.

This illustrates the folly of having an individual-level market in health insurance; the logic of risk-classification is flatly contrary to the Â logic of risk-spreading. Â You want insurance against the cost of being sick or injured. But if you have to buy health insurance one year at a time, Â then the only risk the market will insure you against is the cost this year of any accident or injury. Â All the risk of future costs of that accident or injury will fall on you, in the form of higher premiums or out-of-pocket payment if you can’t afford insurance at the higher rate.

In this particular case, the rational private policy of discriminating against crime victims works against the public policy of enforcing the law. Â In effect, the insurance companies act as accessories-after-the-fact to the batterers, pressuring their victims not to complain, and even not to seek medical treatment for their injuries.

If liberals had an echo chamber the way the wingnuts do, we would never allow opponents of health care reform to live this one down. Â Instead of anwering objections to the various bills being proposed, we’d have people screaming at the critics, “Why do you want to kill battered women?”

But since we don’t want to grow into our enemies, we can’t do that. Â What we can do is to bring up this example every time someone defends “the market” against “government regulation.” Â Is that person in favor of banning “pre-existing condition” discrimination against battered women? Â If not, that person discredits himself. Â If so, then he should be asked what principle forbids that discrimination but allows discrimination against people who have had cancer.

Opponents of reform are defending a status quo that includes denying health insurance to victims of domestic violence. Â Let’s not let them, or the voters, forget it.

Comments

Though it goes against every value I hold, I find myself sometimes wishing that those advocating battering as a pre-existing condition and therefore not to be covered by insurance might find themselves in that very position, with children to protect and their very lives at stake. There's an enormous lack of empathy in high places.

From the insurance company's point of view, the logic is even stronger than that. Someone who has been battered is at greater risk for depression, for substance abuse, for stress-related illness and quite likely for accidental injury in general (because a constant background of "I hope I don't get hit again tomorrow, and I hope the kids are safe" tends to make attention at crucial moments that much harder). One hates to say "banality of evil" but I can't think of many better current examples.

Meanwhile, this line, "the logic of risk-classification is flatly contrary to the logic of risk-spreading" applies far more widely than individual health insurance. Reports in the business press (lauding the practice as progress) notes that insurance companies are using detailed simulations of many kinds to tailor policies for insurance against flood, fire, wind and other disasters. Homeowners don't have access to similar data troves and computing power, so the information asymmetry is all in the direction of the companies, with predictable results: you pay premiums for coverage against things that aren't going to happen, and don't have coverage for the things that will.

This is an example of terrible insurance companies and Congress's weakness. But it's not going to sell the public on Obama's health care. The most reasonable-sounding right-wing criticism (I mean, the criticism most likely to appeal to indendents) of healthcare is that all we need is "Insurance Reform."

Insurance reform would get us out of this particular problem. It won't solve anything else, of course. But it's the aspects of health care that are not "insurance reform" related that we most need to argue for.